Objectives: Shared decision making (SDM) is a central component in a recovery-oriented practice. While decision aids are essential for implementing SDM, they are still lacking within psychiatric services. The aim of this study was to develop a user-generated, web-based decision aid to support shared decision making in Swedish mental health services.

Methods: A decision aid was developed and tested in a preliminary study using a community-based participatory design. This digital tool was then included in a multifaceted intervention study which included staff training and an implementation study that included process and impact evaluation.

Results: Models created for SDM in somatic care, fit well for mental health services. However, the results also suggest adaptations since decisions related to mental illness are often complex and involve multiple life domains. Issues related to social context and individual recovery point to a focus on establishing cooperation as well as follow-up over time.

Conclusions: The study contributes to an understanding of decisional and information needs, as well as relationship-based and cognitive factors important to consider in adapting SDM in the community mental health system. The decision aid which resulted can strengthen service users’ experience of self-efficacy and control as well as giving staff access to user knowledge and preferences.